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Irradiation Question


Brenda K Hutson

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I had something occur this morning that is somewhat unnerving; wanted to see what others thought.

As I mentioned in a recent post, the new place I work at gives all Irradiated RBCs (a process I am going to re-visit; due to the time it takes for me to reverse charges; the decreased expiration; the lost cost from all of the patients we cannot charge for Irradiation; etc).

Today, it was brought to my attention that we had received 3 units of "Irradiated" RBCs from our Supplier, which did not have the lavender Irradiation Label. The Product Code Label, was that for an Irradiated Unit. In my previous life, I would have sent such a unit, right back to the Donor Facility from which it came. However, 1 of these units was a Jka- unit we had requested for a Cancer Patient being transfused today. There have been some problems providing blood for him in the past, so I did not want to cancel if possible. By the time I came into work, the Tech. had asked the Donor Facility to Fax us a copy of the unit paperwork, indicating it was Irradiated (which in my mind, does not resolve the missing label; after all, the Product Code label said it was Irradiated). The Donor Facility assured me that someone "higher up" at their Facility said it did not have to have the lavender label; that is was ok to transfuse. I still was not totally convinced, but decided to keep the Jka- unit for the patient, but return the other 2 non-labeled units to the Donor Facility. The Donor Facility later called and said to just discard them! I was puzzled; after all, if the units were "perfectly acceptable" according to them, why would they discard them instead of taking them back? :confused: I expressed my dismay. They later called again and said they would take them back; but I suspect they will just discard them.

Anyway, wanted your input...

1. Would you have accepted the unit(s) without the lavendar irrradiated label?

2. What is your "take" on the Donor Center's response?

Thanks,

Brenda Hutson

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The unit may have been irradiated in a "batch" which may explain why there wasn't a purple sticker on it. For your peace of mind ask to see the irradiation batch log for the unit in question.

Several years ago I brought up an blood irradiator and you did not have to put one of those purple stickers (the ones that the middle turns black on when exposed to the radiation) on every unit. The NRC regs at the time outlined that the batch needed a sticker, not each individual unit. We did however put a plain, regular purple "irradiated" sticker (much cheaper!) on the bags that were in the same batch. Those indicator stickers were $1.50 apiece!! Maybe they just forgot to put the plain sticker on the units in the batch??

I think you did the right thing, a Jka neg unit is a valuable thing and you don't want to delay patient care if possible. I do think your blood center's response was a little "unusual" but remember, you may have been talking to a bench tech who later cleared the final answer with the manager.

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They had better not be mislabeling units as irradiated! Of course it is bad for patients but the FDA would eat them alive!

I was told once that if your MDs can make an argument that it is of medical advantage you your patients to have all unit irradiated then you can charge for it. i believe that part of that argument could be that you don't want to run the risk of missing irradiation for someone that needs it. In Japan all blood is irradiated due to the higher likelihood there of recipients and donors sharing HLA types. Maybe if your new community is highly in-bred you can justify irradiating everything on those grounds. :)

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Actually, I have found out (through Blood Bank Billing consultants in this country) that you cannot charge all patients for Irradiated just because your Medical Executive Committee approves the product. I believe that would probably be an exception if your Facility is a Cancer Center. I was told emphatically that you can only charge Irradiated if the patient needs it by diagnosis. This is different than Leukoreduction. I know that some time ago, I changed all of our RBC products at the Hospital I worked at, to Leukoreduced. That was before so many Donor Facilities had switched; but Red Cross had already switched. I think there was a lot of data out there and it was becoming the standard-of-practice; that is why it was different.

Brenda Hutson

They had better not be mislabeling units as irradiated! Of course it is bad for patients but the FDA would eat them alive!

I was told once that if your MDs can make an argument that it is of medical advantage you your patients to have all unit irradiated then you can charge for it. i believe that part of that argument could be that you don't want to run the risk of missing irradiation for someone that needs it. In Japan all blood is irradiated due to the higher likelihood there of recipients and donors sharing HLA types. Maybe if your new community is highly in-bred you can justify irradiating everything on those grounds. :)

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If it is their practice to irradiate in batches with only one black indicator sticker per batch I could accept someone forgetting the plain purple sticker - as long as they could show the logsheet from the irradiator itself showing that unit number had gone through the process (not printscreens from blood bank computer just showing code changes made - proves nothing)

Our irradiator is run by laptop which requires entry of each unit number at the end of a cycle and printing of the report. It's useful for lookbacks at times if there is confusion in blood bank computer entries and you want to see what physically happened. I would assume all blood banks with an irradiator have some sort of equivalent report or manual logbook. CYA!

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We recieve irradiated products from two different suppliers who always placed the irradiation sticker on these products. I would be very skepticle if recieving an irradiated product without an irradiation sticker and the supplier does not offer evidence that the unit was indeed irradiated. This ultimately is a patient safety issue.

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Well, I would think that from a billing standpoint, one would then use that argument for all special needs (i.e. Irradiated; CMV-, Antigen Negative, HgbS Negative, etc.); that we want to restrict ALL patients because we are afraid we might miss someone. I think that if you are in an Institution that has a large number of patients who do have a specific requirement (i.e. IRR and possibly CMV- in Cancer Center), that you probably can get away with that. Otherwise, I am told you cannot (but that is just what I was told).

Thanks,

Brenda

They had better not be mislabeling units as irradiated! Of course it is bad for patients but the FDA would eat them alive!

I was told once that if your MDs can make an argument that it is of medical advantage you your patients to have all unit irradiated then you can charge for it. i believe that part of that argument could be that you don't want to run the risk of missing irradiation for someone that needs it. In Japan all blood is irradiated due to the higher likelihood there of recipients and donors sharing HLA types. Maybe if your new community is highly in-bred you can justify irradiating everything on those grounds. :)

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